Thursday, March 6, 2008

Carney Recommendation Stirs Opposition

State Attorney General Martha Coakley is meeting with strong community opposition to the call for an end to acute care at Carney Hospital in Dorchester.

The recommendation was part of a report for the Attorney General on providers affiliated with the Catholic Archdiocese of Boston in the Caritas Christi Health Care System. The 197-bed community teaching hospital has been serving Dorchester and surrounding areas since 1863. Long a fixture among the mostly Irish-American population in Dorchester and surrounding communities, the Carney has increasingly been used by the current local population, much of it people of color and immigrants.

The Carney has also for many years been one of Boston’s leading providers of care to needy patients and the uninsured. The consultants for the Attorney General, Health Strategies & Solutions, say the Carney Hospital has “a long history of poor financial performance financial problems, low inpatient occupancy, and an aging and out of date physical plant with pent-up capital needs.”

In her letter accompanying the report, Coakley wrote, “Carney’s future should be based on current community need, not on historical service lines. Accordingly, acute medical-surgical inpatient hospital care may not be the appropriate future for Carney. The growth areas of health care are almost universally found in ambulatory settings and Greater Boston has no shortage of medical-surgical inpatient beds.” Coakley also wrote that the Carney’s dependence on state funding was of “significant concern.”

A director of the Health Reform Program at the Boston University School of Public Health, Alan Sager, calls the recommendation for the Carney “shocking.”

“There’s not another hospital in the city of Boston whose removal would tear more of a gaping hole—geographically—in the fabric of care,” said Sager.

“The Carney serves people who, if displaced, would be vulnerable to deprivation of needed care,” he said.

Sager says the effect on other hospitals could be destabilizing.

"If the Carney closes," he said, "the financial problems associated with its patient mix will migrate to other hospitals."

The recommendation is also meeting with strong opposition from administrators of Dorchester community health centers. They say the change would disrupt care for patients served by health center physicians with admitting privileges at the Carney.

“If the Carney closes, we would have to re-route a significant part of our patients,” said the president and CEO of Harbor Health Services, Daniel J. Driscoll.

He says the Carney is important for patients with chronic disease and substance abuse problems who occasionally need hospitalization.

“This is not the time to be cutting back on a low-cost community hospital that has both an emergency room and an inpatient psychiatric unit,” said Driscoll.

“Hospitals, doctors and patients live in a very complex ecology, and uprooting one of the three components disrupts the other two very badly,” said Sager.

“This is a great blow,” said Driscoll, “to the ability of Dorchester’s community health centers to care for the community in an effective and cost-efficient manner.”

Sager says the end of acute care at the Carney would force patients to use other teaching hospitals that are more expensive, thus increasing pressure on the costs to HMOs.

“If the Carney is closed as an acute care hospital,” said Sager, “people in our state will be propelled farther and faster toward unaffordable hospital care.”

Boston City Council President Maureen Feeney says the recommendation adds to uncertainty faced by hospital staff and the community. Feeney also represents the part of Dorchester where the hospital is located.

Coakley noted there could be more need for inpatient specialties that could provide the Carney with more fiscal and operational stability. She also said any long term plan for the Carney would have to address the availability of emergency services and include “substantial input from the Dorchester community.”

But Feeney says making the Carney a behavioral health services facility would be a “disservice to the community.”

“There is little doubt that Carney faces challenges,” Feeney said in a statement issued today. “I recognize that continuing to operate as is and under the current structure of Caritas is not a viable option. However, I am unconvinced that the future of Carney does not include acute care. It is clear to me and our local elected leadership, that this community needs the services that Carney provides. I believe that we do need a complete and comprehensive community needs assessment to more fully understand the ways in which Carney can continue serving the communities of Dorchester and the wider metro Boston area.”

Consultants also recommend that governance of the entire Caritas system have more independence from the Archdiocese of Boston. They say strategic, operational, and financial matters should be controlled by an independent board of governors, with matters of religious direction left to the Archdiocese.

Consultants also recommended that St. Elizabeth’s Medical Center in Brighton should continue realignment as a community teaching hospital competing in two or three service areas.